RESUMEN
Aim: To evaluate the efficacy of selective laser trabeculoplasty (SLT) in Southeast Asian eyes with primary open-angle glaucoma (POAG) vs primary angle-closure glaucoma after peripheral iridotomy (PACG-PI). Materials and methods: Records of glaucoma patients who underwent SLT and had a 24-month follow-up were reviewed. Pre- and post-treatment intraocular pressure (IOP), percentage of IOP reduction in POAG, and PACG-PI groups, and probability of failure were analyzed. SLT failure was defined as any eye that did not have IOP lower than 20% compared to the baseline or had an IOP higher than the baseline on two consecutive visits. Adding medication, repeating SLT, or surgical intervention to control IOP was also considered a failure. Results: Sixty-three POAG and 12 PACG-PI eyes were eligible. The mean (standard deviation [SD]) age was 62.9 (10.2) years in POAG and 60.3 (6.2) years in PACG-PI. Mean (SD) prelaser IOP in POAG was 19.0 (4.4) mm Hg and 20.7 (4.7) mm Hg in PACG-PI. At 24 months post-SLT, mean (SD) IOP was 14.1 (4.7) mm Hg and 13.6 (2.0) mm Hg in POAG and PACG-PI, respectively. There was no significant difference in percentage of IOP reduction (22.8 ± 23.0% for POAG and 30.7 ± 19.5% for PACG-PI, p = 0.96), or failure probability (p = 0.10) between both groups. Conclusion: The efficacy of SLT at 24 months was comparable between POAG and PACG-PI. Clinical significance: Selective laser trabeculoplasty may be an option to further lower IOP in eyes with angle closure with visible trabecular meshwork (TM) after iridotomy, especially in highly pigmented eyes of Southeast Asians. How to cite this article: Wongwuticomjon T, Chansangpetch S, Inobhas A, et al. Efficacy of Selective Laser Trabeculoplasty in Primary Angle-closure Glaucoma after Peripheral Iridotomy. J Curr Glaucoma Pract 2022;16(2):124-127.
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PURPOSE: The effect of statins on wound healing is controversial, and their effect on trabeculectomy outcomes remains unclear. This study aimed to examine the relationship between oral statin use and trabeculectomy outcomes. METHODS: Medical records of patients who underwent primary mitomycin-C augmented trabeculectomy with 2 years of follow-up were reviewed. Pre- and postoperative intraocular pressures (IOP) and numbers of medications, subconjunctival 5-fluorouracil (5-FU) injections, and bleb-needling procedures were compared between statin users and nonusers. Failure was defined as an eye that failed to achieve a 20% lowering of IOP from baseline or had an IOP > 21 mm Hg, as well as an eye that required further surgical intervention, developed hypotony, or had no light perception visual acuity. RESULTS: In total, 158 subjects were enrolled, with 47 eyes from statin users and 111 eyes from statin nonusers. The 24-month cumulative probability of failure was 78.7% for statin users and 60.4% for nonusers (P = .013). Cox proportional-hazards modeling showed a significantly higher hazard risk in statin users (adjusted hazard ratio 1.61, P = .026). There were no significant between-group differences in mean IOPs or number of medications (both P > .05) at 24 months. Multivariable Poisson regression analysis that statin use was associated with increased numbers of 5-FU injections (P = .014) and bleb-needling procedures (P = .031). CONCLUSIONS: This study demonstrated that oral statin use was associated with higher rates of trabeculectomy failure and increased numbers of 5-FU injections and bleb-needling procedures.
Asunto(s)
Glaucoma/cirugía , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Trabeculectomía/métodos , Administración Oral , Adulto , Anciano , Antimetabolitos/uso terapéutico , Femenino , Fluorouracilo/uso terapéutico , Estudios de Seguimiento , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Mitomicina/uso terapéutico , Estudios Retrospectivos , Trabeculectomía/efectos adversos , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate repeatability, reproducibility, and agreement of intraocular pressure measurement with Tono-Pen using Ocufilm and polyethylene wrap tip cover in human eyes. METHODS: This is a cross-sectional, experimental study. A gas-sterilized, polyethylene wrap was used as an alternative for Tono-Pen tip cover. For the right eye, 4 measurements using polyethylene wrap tip cover were done by two examiners (A and B) in random order to assess intra-observer repeatability and inter-observer reproducibility. For the left eye, 4 measurements were done by examiner A using both polyethylene wrap tip cover and Ocufilm in random order to assess intra-observer repeatability and agreement. Bland-Altman plot and intraclass correlation coefficient (ICC) were used in all analyses. Cost minimization analysis was evaluated. RESULTS: For examiner A, the repeatability of polyethylene wrap tip cover was -0.34, 95% limits of agreement (LOA) were -3.04 to 2.36, and ICC was 0.93 in the right eyes. As for the left eyes, the repeatability of polyethylene wrap tip cover was -0.33, 95% LOA were -3.01 to 2.36, and ICC was 0.93. For examiner B, the repeatability of polyethylene wrap tip cover was -0.02, 95% LOA were -2.88 to 2.83, and ICC was 0.92. The inter-observer reproducibility of polyethylene wrap tip cover was 0.36, 95% LOA were -3.34 to 4.07, and ICC was 0.90. The repeatability of Ocufilm was -0.42, 95% LOA were -2.75 to 1.91, and ICC was 0.95. The agreement of polyethylene wrap tip cover and Ocufilm was -0.71, 95% LOA were -5.18 to 3.76, and ICC was 0.83. There were no allergic reactions or serious complications. From the cost minimization analysis, the local cost for polyethylene tip cover was approximately 8 times lower compared to Ocufilm. CONCLUSIONS: Tono-pen with Ocufilm and polyethylene wrap tip cover were used to measure the intraocular pressure. The polyethylene wrap tip cover demonstrated acceptable repeatability, reproducibility, and agreement with Ocufilm in normotensive eyes, and had a good safety profile.